Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding: A review

Table 5 Efficacy and safety of hemospray in the management of non-variceal upper gastrointestinal bleeding (2013-2018)

Study	Type of study	Sample size	Bleeding source	Modality	Outcomes	Results
Leblanc et al[72], 2013	Case series, single arm (July 2011-March 2012)	17 patients	Procedural (12/17) and malignancy related bleeding (5/17)	Monotherapy or rescue therapy	Immediate hemostasis, recurrent bleeding and mortality at 7 and 30 d, and related adverse events	Immediate hemostasis achieved in 100% patient in both groups; 2 patients with recurrent bleeding with 1 of 2 with treatment failure. No adverse events. No related complications
Sakai et al[73], 2016	Case report	1 patient	Ulcer related bleeding	Monotherapy	Immediate hemostasis	Immediate hemostasis achieved. No recurrent bleeding. No adverse events
Chen et al[55], 2015	Retrospectiv single center study; (July 2011-July 2013)	60 patients	21 for nonmalignant nonvariceal upper gastrointestinal bleeding, 19 for malignant upper gastrointestinal bleeding, 11 for lower gastrointestinal bleeding, and 16 for intra-procedural bleeding	Monotherapy	Immediate hemostasis and early rebleeding (≤  72 h)	Immediate hemostasis achieved in 66 cases including upper and lower (98.5 %), with 6 cases (9.5 %) of early rebleeding
Arena et al[74], 2017	Retrospective cohort study; (January 2014-December 2015)	A total of 15 patients, 8 males, mean age 74 yr ± 7.7	Malignancy related bleeding	Monotherapy	Immediate hemostasis, bleeding recurrence, adverse events, clinical outcome at 1 and 6 mo	Immediate hemostasis achieved in 93% (14/15). 3 (21%) patients with recurrent bleeding. 12/14 (80%) with good clinical outcome at 30 d and 50% (6/12) at 6 mo. No related adverse events
Pittayanon et al[75], 2018	Retrospective study; (2011-2016)	99 patients (70.5% were male, age 65 ± 14 yr	Malignancy related bleeding	Monotherapy and adjuvant therapy	Immediate hemostasis, early (≤ 3 d) and late (> 3 d) recurrent bleeding	Immediate hemostasis was 97.7%, with recurrent bleeding in 15% (early) and 17% (delayed). Six-month survival was 53.4%
Baracat et al[76], 2017	Case report	1 patient	Post-sphincterotomy bleeding	Rescue therapy	Hemostasis	Immediate hemostasis achieved
González et al[77], 2016	Case report	1 patient	Post-sclerotherapy bleeding	Monotherapy	Hemostasis	Immediate hemostasis achieved
Sung et al[78], 2011	Prospective single-arm	20 patients (18 men, 2 women; mean age 60.2 yr)	Peptic ulcer bleeding (Forrest score Ia or Ib)	Monotherapy	Immediate hemostasis (max of 2 applications allowed), bleeding recurrence post-operatively, after 72 h endoscopically, and after 30 d via phone; mortality, need for surgery, and complications	Immediate hemostasis in 95 % (19 / 20) of patients; (1/20) with a pseudoaneurysm requiring arterial embolization. Bleeding recurred in 2 patients ≤ 72 h (hemoglobin drop); neither had active bleeding at the 72-h endoscopy. No mortality, adverse events, or procedural-related complications at 30-d
Sinha et al[79], 2016	Retrospective single center	20 patients (median age of 75 yr; 50% men)	Peptic ulcer related bleeding (forrest 1a and 1b)	Adjuvant therapy to adrenaline, or to adrenaline with clips or a thermal device	Immediate hemostasis, 7 and 30-d rebleeding; all-cause and GI-related 30-d mortality	Initial hemostasis was attained in 95% with an overall rebleeding rate (RBR) at 7 d of 16%. No difference between the 7 and 30-d RBR. Hemospray + adrenaline = 100% initial hemostasis and 25% 7-d RBR. Hemospray as third agent = 92% initial hemostasis and 9% RBR. All-cause mortality was 15% with 1 GI-related death (3%)
Haddara et al[80], 2016	Prospective registry; (published 2016)	202 patients	Ulcer related bleeding in 75 patients, malignancy related bleed in 61 patients, procedural related bleed in 35 patients, and other in 31 patients	Monotherapy or rescue therapy	Feasibility, efficacy, re-bleeding rate at day 8 and 30	Application of hemospray was found to be very easy or easy in 31.7 % and 55.4 %, respectively. Immediate hemostasis achieved in 96.5 %. Re-bleeding rate at day 8 and 30 were 26.7 % and 33.5 %, respectively
Yau et al[81], 2014	Retrospective (February 2012-July 2013)	19 patients (mean age 67.6 yr)	Peptic ulcers in 12 (63.2%) patients, Dieulafoy lesions in 2 (10.5%), mucosal erosion in 1 (5.3%), angiodysplastic lesion in 1 (5.3%), ampullectomy site in 1 (5.3%), polypectomy site in 1 (5.3%), and an unidentified lesion in 1 (5.3%)	Monotherapy, adjuvant therapy, and rescue therapy	Immediate hemostasis, recurrent bleeding at 7- and 30 d, mortality at 7 and 30 d (related to GIB), and adverse events (related to Hemospray)	Hemostasis in 14 of 15 (93.3%) patients; Rebleeding within 7 d in 7/18 (38.9%) patients. Potential adverse events in 2 (10.5%) patients (visceral perforation and splenic infarct). Mortality in 5 (26.3%) patients with 1 with hemoperitoneum
Smith et al[82], 2014	Multicenter registry (June 2011-September 2011)	63 patients (44 men; median age 65)	30 patients with ulcer related bleeding	Monotherapy or rescue therapy	Immediate hemostasis	47/55 (85%) patients in monotherapy group achieved immediate hemostasis
Sulz et al[83], 2014	Case series; (published in 2014)	16 patients	NVUGIB, unidentified	Monotherapy or rescue therapy	Immediate hemostasis	Immediate hemostasis of 93.75% (15/16)

NVUGIB: Non-variceal upper gastrointestinal bleeding; GI: Gastrointestinal; GIB: Gastrointestinal bleeding; RBR: Rebleeding rate.